AXXESS COVID-19 Insurance 2


PERKS – Independent Insurance
Please fill in the information of the Insured Person.
Name (as per NRIC) 


NRIC #  (eg., 901010105091)


Military/Police No.



Date Of Birth #  (eg., dd/mm/yyyy)


Gender


Email Address 


Mobile No. (eg., 60123456789)


Please Select your Plan



Total Amount (in MYR)


Add Nomination?

Yes  No

Nomination is MANDATORY if the Insured Person is below the age of 18 years old. Thank you

By proceeding with payment you agree that you have read and agreed to the terms and conditions of coverage under the New AXXESS Covid-19 Insurance Plan 2.

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